Prenatal Diagnosis of Third and Fourth Branchial Apparatus Anomalies: Case Series and Comparison with Lymphatic Malformation.

BACKGROUND AND PURPOSE: Third and fourth branchial apparatus anomalies are rare congenital anomalies. The purpose of this study was to investigate imaging features of these lesions on fetal MR imaging in comparison with lymphatic malformations, the major competing differential diagnosis in these cases. MATERIALS AND METHODS: A retrospective review of our institutional fetal MR imaging database between 1997 and 2019 resulted in 4 patients with confirmed third and fourth branchial apparatus anomalies and 14 patients with confirmed lymphatic malformations. The imaging features were reviewed by consensus, and the Fisher exact test was used to evaluate statistically significant differences between these 2 populations. RESULTS: Four cases of third and fourth branchial apparatus anomalies were imaged at 29 weeks 1 day (range, 23 weeks 1 day to 33 weeks 4 days). All 4 cases demonstrated unilateral, unilocular cysts without reduced diffusion or hemorrhage and a medially directed beaked contour that tapered between the spine and airway at the level of the piriform sinus. Compared with 14 cases of fetal lymphatic malformations imaged at 27 weeks 6 days (range, 21 weeks 3 days to 34 weeks 6 days), third and fourth branchial apparatus cysts were significantly more likely to be unilocular (P < .005) and to have a medially beaked contour (P < .005). The combination of features of unilateral, unilocular, and medially beaked contour was observed only in the fetuses with third and fourth branchial apparatus cysts (P < .001). CONCLUSIONS: The presence of a left-sided unilocular cyst with a medially beaked contour tapering at the level of the piriform sinus suggests the diagnosis of third and fourth branchial apparatus anomaly. Accurate diagnosis in the prenatal period allows proper counseling, genetic work-up, and treatment, potentially sparing patients from recurrent infections and associated morbidity.

Congenital cytomegalovirus infection of the brain: imaging analysis and embryologic considerations.

PURPOSE: To analyze the cortical gyral patterns and myelination patterns in a series of patients with congenital cytomegalovirus infections involving the central nervous system, to correlate them with known developmental events, and to develop a consistent theory regarding their embryogenesis. METHODS: The MR (11 patients) and CT (four patients) studies of 11 patients with congenital cytomegalovirus infections involving the brain were retrospectively reviewed. Analysis was made of myelination patterns, cortical gyral patterns, other areas of maldeveloped brain, and focal brain lesions. RESULTS: Lissencephaly was found in four patients. These patients had very thin cerebral cortices, extremely diminished volume of white matter, delayed myelination, small cerebella, and very enlarged lateral ventricles. Focal areas of dysplastic cortex, presumably polymicrogyria, were found in five patients. These patients had slightly thickened irregular cerebral cortices, slightly diminished volume of white matter, delayed myelination, variably small cerebella, and slightly enlarged lateral ventricles. Two patients had normal cerebral cortices, slightly diminished volume of white matter, delayed myelination, normal cerebella, and slightly enlarged lateral ventricles. Periventricular lesions, representing calcification, or perhaps blood, were seen in all groups. CONCLUSIONS: We postulate that the patients with lissencephaly suffer injury before 16 or 18 weeks gestational age, whereas those with regions of polymicrogyria are injured between approximately 18 and 24 weeks gestational age. Those with normal gyral patterns are probably injured during the third trimester and may have active infections at birth. Moreover, we propose that the finding of cerebellar hypoplasia and myelination delay in association with diffuse lissencephaly or cortical dysplasia should suggest the diagnosis of congenital cytomegalovirus infection.

Lymphoma in the immunocompromised patient.

The increased incidence of malignant lymphomas in patients with congenital or acquired immunodeficiency states is now well recognized. In recent years, acquired immunodeficiency syndrome (AIDS) related non-Hodgkin's lymphoma has accounted for a growing proportion of these aggressive neoplasms. This article reviews the radiographic features of lymphoma in AIDS and non-AIDS immunocompromised patients.